Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout

The present study investigated predictors of treatment outcome and dropout in two samples of PTSD-patients with mixed traumas treated using prolonged imaginal exposure. Possible predictors were analysed in both samples separately, in order to replicate in one sample findings found in the other. The only stable finding across the two groups was that patients who showed more PTSD-symptoms at pre-treatment, showed more PTSD-symptoms at post-treatment and follow-up. Indications were found that benzodiazepine use was related to both treatment outcome and dropout, and alcohol use to dropout. Demographic variables, depression and general anxiety, personality, trauma characteristics, feelings of anger, guilt, and shame and nonspecific variables regarding therapy were not related to either treatment outcome or dropout, disconfirming generally held beliefs about these factors as contra-indications for exposure therapy. It is concluded that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome or dropout. Clinically seen, it is therefore argued that exclusion of PTSD-patients from prolonged exposure treatment on the basis of pre-treatment characteristics is not justified.     

Comparison of Cognitive-Behavioral Stress Management Techniques With Adolescent Boys

This study examined the effectiveness of two cognitive-behavioral interventions to help adolescent boys cope with stress and other forms of negative emotional arousal. One group of youths, those receiving cognitive restructuring, learned how to identify and monitor stress-promoting cognitions, restructure these cognitions into more adaptive thoughts, and practice and apply these acquired skills. Another group of youths received anxiety management training, and they were taught to recognize cues that signal the onset of anxiety and to react to these cues using various relaxation skills to reduce the anxiety. The youths who received training were compared with a waiting list control group on measures of anxiety, anger, self-esteem, depression, and reports of anxious self-statements. Both groups that received the intervention showed significant reductions in levels of state and trait anxiety, state anger, anger expression, and depression. These treatment gains were maintained at an 11-week follow-up.     

Cognitive Reappraisal

A central tenet of Beck’s cognitive therapy (or cognitive behavior therapy) of the emotional disorders is that change in negative thought and beliefs is necessary for clinically significant symptom reduction in anxiety, depression, and other psychological conditions. Cognitive restructuring, a uniquely Beckian innovation, is a treatment strategy that directly targets cognitive reappraisal as the change mechanism responsible for symptom reduction. This commentary considers the origins of cognitive reappraisal in Beck’s cognitive therapy through the lens of cognitive restructuring and what treatment process research tells us about the mechanisms of change in cognitive restructuring.     

The Relationship of a Measure of Frustration Intolerance with Emotional Dysfunction in a Student Sample

This study extended earlier research (Harrington in Cong Ther Res 30:699–709, 2006) on the relationship of the multidimensional Frustration Discomfort Scale (FDS) with measures of depressed mood, anxiety and anger, independent of self-esteem. The study employed a non-clinical student sample (N = 323) and measures of both state and trait anger and anxiety. In addition, the Unconditional Self-Acceptance Questionnaire (USAQ) was also used to specifically assess REBT self-acceptance beliefs regarding self-worth, as well as a measure of self-esteem. A Serbian version of the FDS was developed for use in the study. Consistent with the earlier research, significant predictive relationships were found, whilst controlling for self-worth, between entitlement and anger, emotional intolerance and anxiety, and discomfort intolerance with depressed mood. Emotional intolerance also proved to be a significant positive predictor of depression, whilst achievement frustration had a negative relationship with depression. Overall, the FDS dimensions had a weaker relationship with emotional states than traits. The results are discussed in regard to the relationship between FDS dimensions and dysfunctional emotions in a non-clinical sample.     

Rational-Emotive Behavior Therapy in the Treatment of Adult Victims of Childhood Sexual Abuse

This study investigated the effectiveness of Rational-emotive behavior therapy in the treatment of adult victims of childhood sexual abuse. A sample of 42 women, seeking help for their psychological distress associated with childhood sexual abuse, was selected by means of an assessment interview and the Trauma Sympton Checklist, and randomly assigned to a treatment (n=28) and a delayed treatment control group (n=14). The treatment group participated in 10 weekly sessions of group Rational-emotive behavior therapy and was followed up 8 weeks after termination of treatment. Repeated measurements were obtained by means of the Beck Depression Inventory, State-Trait Anxiety Scale, State-Trait Anger Scale, Guilt Inventory, Coopersmith Self-Esteem Inventory and Golombok-Rust Inventory of Sexual Satisfaction. Results indicated significant reductions in depression, State anxiety, State anger, State guilt and low self-esteem. These improvements were maintained at follow-up.     

Belief in good luck and psychological well-being: the mediating role of optimism and irrational beliefs

The authors examined the relationship of belief in good luck with depression and anxiety within the context of a number of cognitive and personality variables used to explain depression and anxiety. Undergraduate students (46 men, 98 women) were administered measures of belief in good luck, depression, anxiety, optimism, neuroticism, attribution style, self-esteem, and irrational beliefs. The results showed that belief in good luck was significantly related to optimism and irrational beliefs. A number of models were tested to determine whether irrational beliefs or optimism mediated the relationship between belief in good luck and depression and anxiety. The findings suggested that negative relationships between belief in good luck and both depression and anxiety are best addressed by the theory that belief in good luck engenders optimistic traits and a reduced level of irrational beliefs.     

Predictors of Anxiety and Depression in Emerging Adulthood

This study constructed a multifactorial model predicting depression and anxiety symptoms among emerging adults, incorporating broad constructs representing adult attachment style, perceived trauma, self-esteem, and irrational beliefs. In the final structural equation model, attachment avoidance and perceived trauma demonstrated direct and indirect effects, whereas attachment anxiety predicted depression only indirectly through low self-esteem or irrational beliefs, and chronic anxiety. Chronic anxiety played a crucial role in linking low self-esteem and irrational beliefs to depression. The theoretical and clinical implications of the findings are discussed.     

Are Gay Men in Worse Mental Health than Heterosexual Men? The Role of Age, Shame and Guilt, and Coming-Out

Previous studies reporting that gay individuals are in worse mental health than heterosexuals have typically employed young or mixed-age samples, ignoring the role of age. Mental health problems may show greater age-related improvement among gay than heterosexual men as indicated by the findings of the present study. In this study, the following indices of mental health are examined, and found to be comparable, among 86 heterosexual and 81 gay men aged 18–48: depression, suicidality, anger, anxiety, negative self-esteem, emotional instability, and lack of emotional responsiveness. Most indices show age-related effects among gay men, with less severe symptoms reported by older individuals. Among heterosexual men, effects of age are less widespread, although older men do report fewer symptoms of anger. Chronic shame and chronic guilt are related to mental health problems and a lessening in shame accounted, in part, for the age-related decline in depression among gay men. Different approaches to disclosing/concealing sexual identity are also linked with shame, guilt, and mental health among gay men.     

Depression, self-esteem, and the absence of self-protective attributional biases

Previous research has demonstrated a relation between depression and attributional style. In the present study we evaluated the extent to which self-esteem may be an important determinant of attributional style. Subjects completed measures of self-esteem, depression, and anxiety and responded to the Attributional Style Questionnaire. Maximum R2 analyses revealed that for significant one-variable and multivariable regression models, self-esteem accounted for the variation in attributional style on the majority of outcome measures. Depression and anxiety added little beyond the contribution of self-esteem. These findings were consistent for both positive and negative events. In addition, self-esteem accounted for variation in attributional evenhandedness. Results are discussed in terms of the role of self-esteem maintenance in attributional style.     

Assessment of the efficacy of a psychological treatment for women victims of violence by their intimate male partner

This study evaluates the long-term efficacy of a brief psychotherapeutic cognitive-behavioral program in group format for female victims of violence by their intimate partner. 53 battered women were randomized into one of two intervention programs: one including among others exposure technique (n = 28) and another one in which exposure procedures were substituted by communication skills training (n = 25). Additionally, both programs included: psycho-education, breath control, training to improve self-esteem, cognitive restructuring, problem-solving, planning pleasant activities, and relapse prevention. The treatment was carried out in 8 weekly sessions. Measures of posttraumatic symptoms, anxiety, depression, self-esteem and anger expression were analyzed at pre- and post-treatment, and at 1-, 3-, 6- and 12-months follow-ups. Results show a pronounced decrease of posttraumatic, depressive and anxiety symptoms, which maintained in the different measure moments, with scarce difference between the two programs. The results and their clinical implications are discussed.     

Dimensionality of the Rosenberg Self-Esteem Scale and Its Relationships With the Three-and the Five-Factor Personality Models

The interpersonal correlates of the Guilt Inventory (Kugler &; Jones, 1992), which yields scores for state guilt, trait guilt, and moral standards, were assessed. Data collection addressed three issues including the relationships among Guilt Inventory scores and measures of: (a) interpersonal emotions and traits (e.g., shyness, self-consciousness, anger, etc.); (b) the social support network; and (c) ratings of trait guilt, moral standards, and relevant adjectives by friends and family members. Results indicated that trait and state guilt scores were significantly related to various interpersonal measures, most particularly, depression, anxiety, shyness, and loneliness, but only modestly related to satisfaction with social support. Moral standards were generally unrelated to these variables. Others tended to rate participants higher on trait guilt negatively (e.g., higher on contemptuous, angry, guilty, etc.), and participants higher on moral standards in socially acceptable terms (e.g., higher on prompt, self-reliant, moral, and religious). Results are interpreted in view of the frequently cited distinction between social and nonsocial emotions.     

Interpersonal correlates of the guilt inventory

The interpersonal correlates of the Guilt Inventory (Kugler & Jones, 1992), which yields scores for state guilt, trait guilt, and moral standards, were assessed. Data collection addressed three issues including the relationships among Guilt Inventory scores and measures of: (a) interpersonal emotions and traits (e.g., shyness, self-consciousness, anger, etc.); (b) the social support network; and (c) ratings of trait guilt, moral standards, and relevant adjectives by friends and family members. Results indicated that trait and state guilt scores were significantly related to various interpersonal measures, most particularly, depression, anxiety, shyness, and loneliness, but only modestly related to satisfaction with social support. Moral standards were generally unrelated to these variables. Others tended to rate participants higher on trait guilt negatively (e.g., higher on contemptuous, angry, guilty, etc.), and participants higher on moral standards in socially acceptable terms (e.g., higher on prompt, self-reliant, moral, and religious). Results are interpreted in view of the frequently cited distinction between social and nonsocial emotions.     

Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders

The aim was to evaluate the efficacy of a manualized cognitive-behavioural program based on habit reversal for the management of chronic tic disorder (CTD) and habit disorder (HD). Forty-seven CTD and 43 HD received a 4-month treatment program. Thirty-eight (22 CTD, 16 HD) were placed on a waitlist control group, which subsequently received treatment. The treatment approach combined awareness training, relaxation (including modification of a tension-producing style of action), and habit-reversal training, with more general cognitive restructuring of anticipations linked to ticcing. Sixty-five percent of completers reported between 75 and 100% control over the tic. At 2-year follow-up, 52% rated 75-100% control. There were also significant changes post-treatment in measures of self-esteem, anxiety, depression and style of planning action. Successful tic/habit modification was associated in CTD and HD groups with successful change in style of planning action. There were no consistent differences in any outcome measures between CTD and HD groups.     

Changes in Emotions Over the Course of Dialectical Behavior Therapy and the Moderating Role of Depression,Anxiety, and Posttraumatic Stress Disorder

Evidence-based borderline personality disorder (BPD) treatments such as dialectical behavior therapy (DBT) emphasize the acquisition and use of strategies to down regulate negative emotion. However, little research examines whether specific emotions change during DBT. Further, it is unclear if BPD-relevant comorbidities that involve heightened emotion—namely, depression, anxiety disorders, and posttraumatic stress disorder (PTSD)—moderate these outcomes. This study investigated which specific emotions (hostility/anger, fear, shame/guilt, and sadness) decrease during DBT, and whether comorbid depression, anxiety disorders, and PTSD moderate these outcomes. Individuals with BPD (N = 101) completed 6 months of standard DBT and provided measurements of specific emotions at every session and at pre-, mid-, and posttreatment. Generalized estimating equations revealed moderate effect-sized reductions in anger at major assessment time points. Anxiety disorders and PTSD moderated the effect of time on fear, shame, and guilt. PTSD also moderated the effect of time on sadness. For all moderating effects, individuals with the comorbidity exhibited greater reductions than those without. These findings corroborate that DBT reduces several specific emotions, and comorbid PTSD and anxiety disorders may facilitate this effect for fear, shame/guilt, and sadness (clinical trial registration number = NCT03123198).     

Differentiating anxiety and depression in older adults with generalized anxiety disorder

To examine affect and cognition in differentiating anxiety and depression, 83 older participants with generalized anxiety disorder completed the Cognitive Checklist (CCL) and the Positive and Negative Affect Schedule (PANAS). A 3-factor solution was found for the PANAS: positive affect (PA), anxiety and anger (Negative Affect 1 [NA-1]), and guilt and shame (Negative Affect 2 [NA-2]). A 2-factor structure was noted for the CCL. Correlations with anxiety and depression measures suggested that the CCL Depression (CCL-D) subscale showed stronger correlations with depression, whereas the CCL Anxiety subscale did not uniquely correlate with anxiety. The NA-1 subscale correlated positively with measures of depression and anxiety, whereas the PA subscale showed negative correlations. Hierarchical regression suggested that the CCL-D subscale was a significant predictor of self-reported depression.     

The Relationship Between Frustration Intolerance,Unhealthy Emotions,and Assertive Behaviour in Italian Students

The aim of the present research was to investigate the relationship between frustration intolerance and emotional-behavioural problems. Specifically, the study explored whether frustration intolerance beliefs were associated with difficulties in assertive behaviour, anxiety, depression, and anger in a non-clinical student sample (N = 250). For this purpose an Italian version of the Frustration Discomfort Scale (FDS) was developed. The findings supported a multidimensional model of frustration intolerance and the relationship between specific frustration intolerance beliefs and emotional-behavioural problems. Regarding unhealthy emotions, structural equation modeling (SEM) analyses (model A) indicated that discomfort intolerance and emotional intolerance had a significant relationship with state anxiety, trait anxiety, and depression. The discomfort intolerance and entitlement sub-scales had a significant relationship with state anger and trait anger, while entitlement directly predicted trait anger. Regarding assertiveness, SEM analyses (model B) indicated that emotional intolerance had a significant relationship with distress when being assertive. More generally, the FDS full scale score (model C) was significantly related to unhealthy emotions and (model D) unassertive behaviour (distress). The present study provided evidence of the cross-cultural applicability of the FDS.     

The relationship among guilt, dysphoria, anxiety and obsessions in a normal population

Seventy-six college students reported intrusive thoughts and impulses on a checklist. These students also completed questionnaires assessing depression, trait anxiety and perceived guilt. Results indicated for this normal population that intrusive thoughts were more distressful, more difficult to dismiss and occur with a greater variety of content compared to intrusive impulses. Multiple regression analysis showed that guilt was the best predictor of intrusive thoughts and impulses. Self-reported depression and anxiety were not strong predictors with respect to nonclinical obsessions and impulses. Discussion focuses on the utility of assessing guilt with obsessional disorders, the lack of a relationship between self-report trait anxiety and nonclinical obsessions, and the need to examine the relationship between guilt and anxiety with clinically obsessional subjects.     

Affective correlates of trichotillomania

Affective correlates of hair pulling were investigated in a sample of 44 participants diagnosed with trichotillomania (TM). Participants completed the Hair Pulling Survey on which they rated the intensity of ten different affective states across three different phases of hair pulling (before, during and after). Repeated measures analysis of variance was used to examine the change of emotional experience across the hair pulling cycle. Results indicated significant decreases in boredom, anxiety and tension, and significant increases in guilt relief, sadness and anger across time (p<0.005). The role of co-existent anxiety and mood disorders also was examined using repeated measures analysis of variance. Results of these analyses indicated that patients with and without co-existent disorders differed only on patterns of anger across time, and therefore do not support affective subtypes of TM patients based on co-existent diagnosis. Implications of these findings for conceptualization and treatment of TM are discussed.     

Changes in psychological well-being in female patients with clinically diagnosed depression: an exploratory approach in a therapeutic setting

The objective of this exploratory one-group pretest-posttest study was to evaluate the nature of psychological change in inward depressed psychiatric patients attending multi-disciplinary treatment, including physical activity, designed to improve mental well-being. Female depressed psychiatric patients (n?=?51) were examined before and after this programme over a period of 3 months. The following psychological parameters were assessed: depression, anxiety, global self-esteem, and physical self-perceptions. Depressed patients demonstrated statistically significant improvements in depression, anxiety, global self-esteem and physical self-worth (t(50) ranging from -3.76 to 4.65, all p?相似文献   

Setting and response generalization in rational-emotive therapy: A case study

A single case study (n=1) conducted during therapy investigated the relationship between disputing irrational beliefs in vivo and setting and response generalization. Irrational beliefs associated with the subject's anger and depression were disputed at different intervals over a ten week period utilizing a multiple baseline design across four classes in a school setting (setting 1). Depression and anger were rated several times each week. The subject's level of anxiety was also rated in setting 1 but the irrational beliefs associated with it were not disputed. Anger, depression, and anxiety were rated without disputation in a separate work setting (setting 2). Affect ratings significantly decreased across both settings throughout the ten week period. Results indicated that 1) disputing irrational beliefs associated with anger and depression in setting 1 led to reductions in anxiety in this setting (response generalization), 2) anger and depression reductions in setting 2 paralleled setting 1 reductions (setting generalization), and 3) anxiety reductionsWilliam J. Ruth, PhD, Staff Psychologist and practicum supervisor, Institute for Rational-Emotive Therapy, NY City; School Psychologist, Board of Cooperative Educational Services, Southern Westchester.Raymond DiGiuseppe, PhD, ABPP, Director of Training and Research, Institute for Rational-Emotive Therapy, NY City; Graduate Professor, St. John's University, NY City; co-author,Practitioner's Guide to Rational-Emotive Therapy and RET with Alcoholics and Substance Abusers.